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Rinsho Ganka Volume 39, Issue 5 （May 1985）

臨床眼科 39巻5号（1985年5月発行）

Japanese English

臨床報告

極小未熟児における未熟児網膜症—重症型未熟児網膜症の予後と治療における問題点 Retinopathy of prematurity in extremely low birthweight infants 上田佳代 ¹ , 山名敏子 ² , 西村みえ子 ² , 近藤乾 ³ Kayo Ueda ¹ , Toshiko Yamana ² , Mieko Nishimura ² , Tsutomu Kondo ³ ¹福岡市立こども病院眼科 ²九州大学医学部眼科学教室 ³福岡市立こども病院新生児科 ¹Dep. of Ophthalmol., Fukuoka Children's Hosp. Med. Cent. ²Dept. of Ophthalntol., Fac. of Med. Kyushu Univ. ³Dept. of Pediatr., Fukuoka Children's Hasp. Med. Cent. pp.675-679

発行日 1985年5月15日 Published Date 1985/5/15

DOI https://doi.org/10.11477/mf.1410209446

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Abstract 文献概要
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　1980年9月1日から1983年12月31日までに福岡市立こども病院NICUで経験した出生体重1,500g未満の極小未熟児69例について網膜症発生状況を検討し，さらに重症型網膜症の臨床所見，治療，予後について検討した．

（1）網膜症を発生したのは38例（55.0％），そのうち重症型網膜症は7例（10.1％）であった．

（2）重症型は全例在胎28週以下，出生体重1,000g未満で，人工換気療法を受けていた．

（3）重症型の早期診断は，網膜血管先端の位置が耳側では黄斑部から3.5乳頭径以内，鼻側では乳頭縁から6乳頭径以内で，血管先端に異常吻合，走行異常，軽度の怒張が認められれば，これを重症型と診断してよい．

（4）重症型の治療は，光凝固が第一選択で，診断がつき次第すみやかに開始し，境界部と無血管帯を十分に凝固することが重要である．また，治療によりいったん寛解した網膜症が再燃する場合があり，注意すべきである．

We evaluated retinopathy of prematurity (ROP) in extremely low birthweight infants as to its incidence, clinical features and treatment of severe type. A consecutive series of 69 infants in the past 39-month period were included in the study. All had a birthweight of 1,499 grams or less and were admitted in the neonatal intensive care unit. ROP was detected in 38 cases (55%), of which 7 cases (10%) manifested severe type of ROP.

These 7 cases with severe type of ROP weighed less than 1,099 grams at birth and were less than 28 weeks in gestational age. They were given oxygen through respirator for at least 2 weeks and generally for 4 weeks or more.

As important signs for the early diagnosis of severe type of ROP, wide avascular areas encroaching the posterior fundus were present in all the four quad-rants. Retinal vessels were seen only within 3.5 disc diamaters (DD) from the macula on the temporal side and within 6DD on the nasal side. As further pathognomonic signs, retinal vessels showed anasto-mosis, abnormal course and dilatations in their distal portions. Neovascular membranes into the vitreous and marked generalized vasodilatation soon developed after this stage.

Xenon photocoagulation with additional cryoco-agulation was effective in 10 eyes (5 cases). In order to be effective, pltotocoagulation for the severe type of ROP had to be initiated before generalized dila-tation and tortuosity of retinal vessels and before markedly ingrowth of ncovascular membranes. It is imperative that photocoagulation spots be placed ('lose to one another all over the avascular area and also along the borderline between the vascularized and avascular retina. Should neovascular mem-branes develop in spite of photocoagulation, they should be treated by repeated coagulations.